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Brouwers H, von Hegedus JH, van der Linden E, Mahdad R, Kloppenburg M, Toes R, Giera M, Ioan-Facsinay A. Hyaluronidase treatment of synovial fluid is required for accurate detection of inflammatory cells and soluble mediators. Arthritis Res Ther 2022; 24:18. [PMID: 34998422 PMCID: PMC8742425 DOI: 10.1186/s13075-021-02696-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 12/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Synovial fluid (SF) is commonly used for diagnostic and research purposes, as it is believed to reflect the local inflammatory environment. Owing to its complex composition and especially the presence of hyaluronic acid, SF is usually viscous and non-homogeneous. In this study, we investigated the importance of homogenization of the total SF sample before subsequent analysis. METHODS SF was obtained from the knee of 29 arthritis patients (26 rheumatoid arthritis, 2 osteoarthritis, and 1 juvenile idiopathic arthritis patient) as part of standard clinical care. Synovial fluid was either treated with hyaluronidase as a whole or after aliquoting to determine whether the concentration of soluble mediators is evenly distributed in the viscous synovial fluid. Cytokine and IgG levels were measured by ELISA or Luminex and a total of seven fatty acid and oxylipin levels were determined using LC-MS/MS in all aliquots. For cell analysis, synovial fluid was first centrifuged and the pellet was separated from the fluid. The fluid was subsequently treated with hyaluronidase and centrifuged to isolate remaining cells. Cell numbers and phenotype were determined using flow cytometry. RESULTS In all patients, there was less variation in IgG, 17-HDHA, leukotriene B4 (LTB4), and prostaglandin E2 (PGE2) levels when homogenization was performed before aliquoting the SF sample. There was no difference in variation for cytokines, 15-HETE, and fatty acids arachidonic acid (AA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). Between 0.8 and 70% of immune cells (median 5%) remained in suspension and were missing in subsequent analyses when the cells were isolated from untreated SF. This percentage was higher for T and B cells: 7-85% (median 22%) and 7-88% (median 23 %), respectively. CONCLUSIONS Homogenization of the entire SF sample leads to less variability in IgG and oxylipin levels and prevents erroneous conclusions based on incomplete isolation of synovial fluid cells.
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Affiliation(s)
- Hilde Brouwers
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
| | | | - Enrike van der Linden
- Department of Orthopedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Rachid Mahdad
- Department of Orthopedics, Alrijne Healthcare Group, Leiden, The Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - René Toes
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Martin Giera
- Center for Proteomics and Metabolomics, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Andreea Ioan-Facsinay
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
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La'ulu SL, Turner DR, Zupan E, Genzen JR. Pretreatment of Body Fluid Specimens Using Hyaluronidase and Ultracentrifugation. Lab Med 2021; 52:469-476. [PMID: 33560339 DOI: 10.1093/labmed/lmaa115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Viscous body fluids present challenges during clinical laboratory testing. The present study was conducted to evaluate the effectiveness of hyaluronidase (HYAL) and ultracentrifugation (UC) pretreatment for a variety of body fluids before clinical chemistry testing. METHODS The following body fluids were evaluated: biliary/hepatic, cerebrospinal, dialysate, drain, pancreatic, pericardial, peritoneal/ascites, pleural, synovial, and vitreous. Analytes assessed included amylase, total bilirubin, cancer antigen 19-9, carcinoembryonic antigen, cholesterol, chloride, creatinine, glucose, lactate dehydrogenase, lipase, potassium, rheumatoid factor, sodium, total protein, triglycerides, urea nitrogen, and uric acid. RESULTS Observed percentage differences between HYAL treated and untreated fluids were less than ±15% for all analytes investigated, with a small number showing statistical significance (P <.05). In addition, UC showed increased variability for limited body fluid/analyte combinations. CONCLUSION The HYAL treatment effectively reduced viscosity for body fluids. Validation of specimen pretreatment processes ensures acceptable analytical performance and the absence of unanticipated interferences.
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Affiliation(s)
- Sonia L La'ulu
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, Utah
| | | | | | - Jonathan R Genzen
- ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, Utah.,ARUP Laboratories, Salt Lake City, Utah.,Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah
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[Synovial fluid cytodiagnosis]. REVISTA ESPAÑOLA DE PATOLOGÍA : PUBLICACIÓN OFICIAL DE LA SOCIEDAD ESPAÑOLA DE ANATOMÍA PATOLÓGICA Y DE LA SOCIEDAD ESPAÑOLA DE CITOLOGÍA 2019; 53:100-112. [PMID: 32199591 DOI: 10.1016/j.patol.2019.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 01/05/2019] [Accepted: 01/16/2019] [Indexed: 11/23/2022]
Abstract
Synovial fluid samples represent only a very small percentage of routine work in a cytology laboratory. However, its microscopic examination allows us to observe different types of cells, particles and structures that, due to their morphological characteristics, may provide relevant data for cytodiagnosis. We present certain aspects related to arthrocentesis, the relationship between the gross appearance of synovial fluid and certain pathological processes, as well as the different techniques for processing and staining the smears. Furthermore, we describe the main cytological findings in various pathological conditions of the synovial joints, such as infections (bacterial and fungal), non-infectious inflammatory type (osteoarthrosis, rheumatoid arthritis, connective tissue diseases) and tumoral, distinguishing between primary and metastatic, both solid and haematological neoplasms.
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Sigmund IK, Holinka J, Sevelda F, Staats K, Heisinger S, Kubista B, McNally MA, Windhager R. Performance of automated multiplex polymerase chain reaction (mPCR) using synovial fluid in the diagnosis of native joint septic arthritis in adults. Bone Joint J 2019; 101-B:288-296. [PMID: 30813795 DOI: 10.1302/0301-620x.101b3.bjj-2018-0868.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS This study aimed to assess the performance of an automated multiplex polymerase chain reaction (mPCR) technique for rapid diagnosis of native joint septic arthritis. PATIENTS AND METHODS Consecutive patients with suspected septic arthritis undergoing aseptic diagnostic joint aspiration were included. The aspirate was used for analysis by mPCR and conventional microbiological analysis. A joint was classed as septic according to modified Newman criteria. Based on receiver operating characteristic (ROC) analysis, the area under the ROC curve (AUC) values of the mPCR and the synovial fluid culture were compared using the z-test. A total of 72 out of 76 consecutive patients (33 women, 39 men; mean age 64 years (22 to 92)) with suspected septic arthritis were included in this study. RESULTS Of 72 patients, 42 (58%) were deemed to have septic joints. The sensitivity of mPCR and synovial fluid culture was 38% and 29%, respectively. No significant differences were found between the AUCs of both techniques (p = 0.138). A strong concordance of 89% (Cohen's kappa: 0.65) was shown. The mPCR failed to detect Staphylococcus aureus (n = 1) and Streptococcus pneumoniae (n = 1; no primer included in the mPCR), whereas the synovial fluid culture missed six microorganisms (positive mPCR: S. aureus (n = 2), Cutibacterium acnes (n = 3), coagulase-negative staphylococci (n = 2)). CONCLUSION The automated mPCR showed at least a similar performance to the synovial fluid culture (the current benchmark) in diagnosing septic arthritis, having the great advantage of a shorter turnaround time (within five hours). Cite this article: Bone Joint J 2019;101-B:288-296.
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Affiliation(s)
- I K Sigmund
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
| | - J Holinka
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
| | - F Sevelda
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
| | - K Staats
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
| | - S Heisinger
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
| | - B Kubista
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
| | - M A McNally
- The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals, Foundation NHS Trust, Oxford, UK
| | - R Windhager
- Medical University of Vienna, Department of Orthopaedics and Trauma Surgery, Vienna, Austria
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Abstract
Cytological analysis of synovial fluid is widely used in the clinic to assess joint health and disease. However, in general practice, only the total number of white blood cells (WBCs) are available for cytologic evaluation of the joint. Moreover, sufficient volume of synovial aspirates is critical to run conventional analyses, despite limited volume of aspiration that can normally be obtained from a joint. Therefore, there is a lack of consistent and standardized synovial fluid cytological tests in the clinic. To address these shortcomings, we developed a microfluidic platform (Synovial Chip), for the first time in the literature, to achieve repeatable, cost- and time-efficient, and standardized synovial fluid cytological analysis based on specific cell surface markers. Microfluidic channels functionalized with antibodies against specific cell surface antigens are connected in series to capture WBC subpopulations, including CD4+, CD8+, and CD66b+ cells, simultaneously from miniscule volumes (100 μL) of synovial fluid aspirates. Cell capture specificity was evaluated by fluorescent labeling of isolated cells in microchannels and was around 90% for all three WBC subpopulations. Furthermore, we investigated the effect of synovial fluid viscosity on capture efficiency in the microfluidic channels and utilized hyaluronidase enzyme treatment to reduce viscosity and to improve cell capture efficiency (>60%) from synovial fluid samples. Synovial Chip allows efficient and standardized point-of-care isolation and analysis of WBC subpopulations in miniscule volumes of patient synovial fluid samples in the clinic.
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The added value of synovial fluid centrifugation for monosodium urate and calcium pyrophosphate crystal detection. Clin Rheumatol 2017; 36:1599-1605. [PMID: 28424907 DOI: 10.1007/s10067-017-3633-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 04/05/2017] [Accepted: 04/11/2017] [Indexed: 12/26/2022]
Abstract
The aim of the study was to assess the added value of synovial fluid (SF) centrifugation for microscopic monosodium urate (MSU) and calcium pyrophosphate (CPP) crystal detection in patients with arthritis. This is a prospective observational study using SF samples from joints of patients undergoing joint arthrocentesis. Two blinded observers assessed the SF smears by polarized light microscopy for the presence of crystals before as well as after centrifugation. SF samples were collected from 98 patients with arthritis. After exclusion, 87 samples were eligible for inclusion. Of each sample, 2 smears before and after centrifugation were prepared and microscopically examined, resulting in 348 smears per observer. Observer 1 identified MSU crystals in 18.4% and CPP in 9.2% of the smears before as well as after centrifugation. No extra MSU crystal-positive smears were identified after centrifugation. However, centrifugation yielded 4 additional CPP crystal-positive smears. Observer 2 identified MSU crystals in 15.5% and CPP crystals in 6.3% of the smears before as well as after centrifugation. Centrifugation yielded 2 additional MSU crystal-positive smears and 4 CPP crystal-positive smears. Monosodium urate crystals were well recognized without centrifugation. Centrifugation of SF had limited additional value for increasing the amount of MSU-positive smears. However, CPP crystals were identified in a higher number of smears after centrifugation than before. Therefore, centrifugation may be of additional value in selected patients with suspected calcium pyrophosphate deposition disease and to a lesser extent for gout.
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Van de Water E, Oosterlinck M, Duchateau L, Pille F. Agreement of manual cell counts and automated counts of the scil Vet abc Plus+ hematology analyzer for analysis of equine synovial fluid. Res Vet Sci 2016; 106:62-5. [DOI: 10.1016/j.rvsc.2016.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 03/08/2016] [Accepted: 03/13/2016] [Indexed: 11/30/2022]
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Brudvig JM, Swenson CL. Total nucleated cell and leukocyte differential counts in canine pleural and peritoneal fluid and equine synovial fluid samples: comparison of automated and manual methods. Vet Clin Pathol 2015; 44:570-9. [DOI: 10.1111/vcp.12298] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Jean M. Brudvig
- Department of Pathobiology and Diagnostic Investigation and Diagnostic Center for Population and Animal Health; College of Veterinary Medicine; Michigan State University; East Lansing MI USA
| | - Cheryl L. Swenson
- Department of Pathobiology and Diagnostic Investigation and Diagnostic Center for Population and Animal Health; College of Veterinary Medicine; Michigan State University; East Lansing MI USA
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Robier C, Stettin M, Quehenberger F, Neubauer M. Cytospin preparations are superior to common smears in the detection of monosodium urate crystals in low-cellular synovial fluids. Clin Rheumatol 2014; 33:1797-800. [PMID: 24744156 DOI: 10.1007/s10067-014-2619-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/06/2014] [Indexed: 11/27/2022]
Abstract
In cases of gout with a low synovial fluid (SF) leukocyte count and atypical clinical presentation, such as in intercritical periods, the load of monosodium urate (MSU) crystals is frequently low, and thus, methods to improve the crystal detection may be beneficial. We compared the MSU crystal detection rates between cytospin slides and common smear preparations in low-cellular (<2,000/μl) SF samples of patients with gout. We determined the number of MSU crystals/15 high power fields (HPF) at × 1,000 magnification by polarised microscopy in cytospin preparations and smears in SF samples of 17 patients with MSU-crystal-proven gout and compared the two methods statistically. All of the cytospin slides (100 %) contained MSU crystals and showed a median number of 124 crystals/15 HPF (range 2-3,915), whereas 5 of the 17 smears (29 %) were MSU-crystal-negative, with a median count of 2 crystals/15 HPF (range 0-430/HPF). The difference was statistically highly significant (p < 0.0001). In conclusion, we have shown that the cytospin technique is superior to smears in the detection of MSU crystals in SF with a low SF leukocyte count. In light of our observations, we recommend the use of cytocentrifuges for routine crystal analysis in such cases.
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Affiliation(s)
- Christoph Robier
- Central Laboratory, Hospital of the Brothers of St. John of God, Bergstrasse 27, 8020, Graz, Austria,
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Hyaluronidase treatment of synovial fluid to improve assay precision for biomarker research using multiplex immunoassay platforms. J Immunol Methods 2012; 386:22-30. [DOI: 10.1016/j.jim.2012.08.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2012] [Revised: 07/19/2012] [Accepted: 08/21/2012] [Indexed: 11/19/2022]
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Wei F, Zhou J, Wei X, Zhang J, Fleming BC, Terek R, Pei M, Chen Q, Liu T, Wei L. Activation of Indian hedgehog promotes chondrocyte hypertrophy and upregulation of MMP-13 in human osteoarthritic cartilage. Osteoarthritis Cartilage 2012; 20:755-63. [PMID: 22469853 PMCID: PMC3374008 DOI: 10.1016/j.joca.2012.03.010] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 03/10/2012] [Accepted: 03/22/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objectives of this study were to (1) determine the correlation between osteoarthritis (OA) and Indian hedgehog (Ihh) expression, and (2) establish the effects of Ihh on expression of markers of chondrocyte hypertrophy and matrix metalloprotease (MMP)-13 in human OA cartilage. DESIGN OA cartilage and synovial fluid samples were obtained during total knee arthroplasty. Normal cartilage samples were obtained from intra-articular tumor resections, and normal synovial fluid samples were obtained from healthy volunteers and the contralateral uninjured knee of patients undergoing anterior cruciate ligament reconstruction. OA was graded using the Mankin score. Expression of Ihh in synovial fluid was determined by Western blot. Ihh, type X collagen and MMP-13 mRNA were determined by real time PCR. Protein expression of type X collagen and MMP-13 in cartilage samples was analyzed with immunohistochemistry. Chondrocyte size was measured using image analysis. RESULTS Ihh expression was increased 2.6 fold in OA cartilage and 37% in OA synovial fluid when compared to normal control samples. Increased expression of Ihh was associated with the severity of OA and expression of markers of chondrocyte hypertrophy: type X collagen and MMP-13, and chondocyte size. Chondrocytes were more spherical with increasing severity of OA. There was a significant correlation between Mankin score and cell size (r(2) = 0.80) and Ihh intensity (r(2) = 0.89). Exogenous Ihh induced a 6.8 fold increase of type X collagen and 2.8 fold increase of MMP-13 mRNA expression in cultured chondrocytes. Conversely, knockdown of Ihh by siRNA and Hh inhibitor cyclopamine had the opposite effect. CONCLUSIONS Ihh expression correlates with OA progression and changes in chondrocyte morphology and gene expression consistent with chondrocyte hypertrophy and cartilage degradation seen in OA cartilage. Thus, Ihh may be a potential therapeutic target to prevent OA progression.
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Affiliation(s)
- Fangyuan Wei
- Department of Orthopedics; Warren Alpert Medical School of Brown University, Providence RI 02903
| | - Jingming Zhou
- Department of Orthopedics; Warren Alpert Medical School of Brown University, Providence RI 02903
| | - Xiaochun Wei
- Department of Orthopedics; Shanxi Medical University, Taiyuan, Shanxi, 030001
| | - Juntao Zhang
- Department of Orthopedics; Shanxi Medical University, Taiyuan, Shanxi, 030001
| | - Braden C. Fleming
- Department of Orthopedics; Warren Alpert Medical School of Brown University, Providence RI 02903
| | - Richard Terek
- Department of Orthopedics; Warren Alpert Medical School of Brown University, Providence RI 02903
| | - Ming Pei
- Department of Orthopaedics; West Virginia University, Morgantown, WV, 26506
| | - Qian Chen
- Department of Orthopedics; Warren Alpert Medical School of Brown University, Providence RI 02903
| | - Tao Liu
- Department of Biostatistics/Center for Statistical Sciences; Warren Alpert Medical School of Brown University, Providence RI 02903
| | - Lei Wei
- Department of Orthopedics; Warren Alpert Medical School of Brown University, Providence RI 02903
,Department of Orthopedics; Shanxi Medical University, Taiyuan, Shanxi, 030001
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Robier C, Neubauer M, Stettin M, Rainer F. Microscopic examination of stained cytospin preparations is a reliable method for the detection of calcium pyrophosphate crystals in synovial fluid. Scand J Rheumatol 2011; 40:406-7. [PMID: 21819295 DOI: 10.3109/03009742.2011.588959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ekmann A, Rigdal ML, Gröndahl G. Automated counting of nucleated cells in equine synovial fluid without and with hyaluronidase pretreatment. Vet Clin Pathol 2010; 39:83-9. [DOI: 10.1111/j.1939-165x.2009.00203.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Erne JB, Goring RL, Kennedy FA, Schoenborn WC. Prevalence of lymphoplasmacytic synovitis in dogs with naturally occurring cranial cruciate ligament rupture. J Am Vet Med Assoc 2009; 235:386-90. [PMID: 19681718 DOI: 10.2460/javma.235.4.386] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To determine the prevalence of lymphoplasmacytic synovitis (LPS) in dogs with naturally occurring cranial cruciate ligament (CCL) rupture and compare clinical, radiographic, cytologic, and histologic findings in dogs with and without LPS. DESIGN Cross-sectional study. ANIMALS 110 dogs with naturally occurring CCL rupture. PROCEDURES Histologic examination of synovial biopsy specimens obtained at the time of surgical treatment was used to identify dogs with LPS. Clinical, radiographic, cytologic, and histologic findings were compared between dogs with and without LPS. RESULTS 56 (51%) dogs had histologic evidence of LPS. There were no significant differences in age, body weight, duration of lameness, severity of lameness, severity of radiographic signs of degenerative joint disease, extent of CCL rupture (partial vs complete), or gross appearance of the medial meniscus between dogs with and without LPS. Mean tibial plateau angle was significantly lower in dogs with LPS than in dogs without LPS, and dogs with LPS were significantly more likely to have neutrophils in their synovial fluid. Lymphocytes were seen in synovial fluid from a single dog with LPS. CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that LPS was common in dogs with naturally occurring CCL rupture. However, only minor clinical, radiographic, cytologic, and histologic differences were identified between dogs with and without LPS.
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Affiliation(s)
- Jay B Erne
- Affiliated Veterinary Specialists, 275 Corporate Way, Ste 100, Orange Park, FL 32073, USA
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Sugiuchi H, Ando Y, Manabe M, Nakamura E, Mizuta H, Nagata S, Okabe H. Measurement of total and differential white blood cell counts in synovial fluid by means of an automated hematology analyzer. ACTA ACUST UNITED AC 2005; 146:36-42. [PMID: 16025090 DOI: 10.1016/j.lab.2005.04.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We developed a rapid and accurate method for quantifying total and differential white blood cell (WBC) counts by pretreating synovial fluid with hyaluronidase and using an automated hematology analyzer. Forty-seven samples of synovial fluid that had been placed in blood-collection tubes containing ethylenediamine- N,N,N',N' -tetraacetic acid as an anticoagulant were treated with hyaluronidase at 37 degrees C for 10 minutes, and then the total and differential WBC counts were determined by means of the automated hematology analyzer. Results were compared with those achieved by traditional manual counting methods. For the automated method, the coefficient of variation values for within-run precision of the WBC count were 5.27%, 3.56%, and 3.01% at 0.54, 1.12, and 2.05 x 10(9) /L, respectively; the run-to-run coefficient of variation values was less than 10.0%. The total and differential WBC counts obtained by this automated method showed good correlation with those obtained by the hemocytometer method ( r = .998; P < .0001; regression formula, y = 0.986 x - 0.072). Bland-Altman plots indicated no significant discrepancy between the methods. Our evaluation supports the use of this automated hematology analyzer method to measure total and differential WBC counts, which should aid clinical diagnosis.
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Affiliation(s)
- Hiroyuki Sugiuchi
- Department of Laboratory Medicine, Kumamoto University Medical School, Kumamoto, Japan
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Chen LX, Clayburne G, Schumacher HR. Update on identification of pathogenic crystals in joint fluid. Curr Rheumatol Rep 2004; 6:217-20. [PMID: 15134601 DOI: 10.1007/s11926-004-0071-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Crystal identification in joint fluid has been an essential part of diagnosis of joint disease. Recent advances have included progress in crystal identification on stained slides, attention to aspiration techniques, and arthrocenteses of asymptomatic joints. Challenges remain to increase use and optimize techniques.
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Affiliation(s)
- Lan X Chen
- VA Medical Center, 151K, University and Woodland Avenues, Philadelphia, PA 19104, USA
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Swan A, Amer H, Dieppe P. The value of synovial fluid assays in the diagnosis of joint disease: a literature survey. Ann Rheum Dis 2002; 61:493-8. [PMID: 12006320 PMCID: PMC1754135 DOI: 10.1136/ard.61.6.493] [Citation(s) in RCA: 171] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To carry out a critical appraisal of the literature in an attempt to assess the current value of synovial fluid (SF) analysis in the diagnosis of joint disease. METHODS A literature search was undertaken using the Medline, Biomed, Bids, Pubmed, and Embase electronic databases using the keywords: synovial fluid (SF) analysis, SF crystals, joint sepsis, acute arthritis, and SF cell counts, cytology, biomarkers, and microbiology. RESULTS Publications fell into three main categories. Firstly, reports assessing the value of the three traditional assays (microbiology, white blood cell counts, and microscopy for pathogenic crystals). For these quality control evidence was found to be sparse, and tests for sensitivity, specificity, and reliability showed worrying variations. These poor standards in SF analysis may be due to lack of inclusion of some tests within routine pathology services. Secondly, claims for the usefulness of "new" assays (cytology and biochemical markers). For cytology, the supporting evidence was mainly anecdotal and there were no reports on specificity, sensitivity, and reliability. Interpretation difficulties are a major hindrance to the clinical use of biochemical assays, which remain primarily research tools. Finally, work on the diagnostic value of SF analysis in general. The appraisal confirmed that SF analysis remains of major diagnostic value in acute arthritis, where septic arthritis or crystal arthropathy is suspected, and in intercritical gout. CONCLUSIONS Given the importance of SF tests, rationalisation of their use, together with improved quality control, should be immediate priorities. Further investigation is recommended into the contribution of SF inspection and white cell counts to diagnosis, as well as of the specificity and sensitivity of SF microbiological assays, crystal identification, and cytology.
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Affiliation(s)
- A Swan
- Division of Medicine, University of Bristol MRC Health Services Research Collaboration, Department of Social Medicine, University of Bristol, UK.
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